The Obamacare Marketplace Exchange Guide

Like it or not, the biggest component of the Affordable Care Act (aka Obamacare) – publicly run health insurance exchanges – have arrived.

So what’s next?

At the most basic level:

1. If you have insurance through your employer, Medicaid, Medicare, COBRA – you can keep it.

2. If you want to keep or get insurance through a private exchange or individual insurer, you can – nothing changes (but you might miss out on the new subsidies).

3. You now have the additional option to get insurance through a state or public exchange at healthcare.gov. Subsidies, based on income level, are only available for plans purchased from public exchanges.

4. If you don’t have health insurance at all, you will now be subject to a tax penalty.

The reality is, in the quest to find affordable health insurance, you really should explore all available options (except #4, which is an incredibly risky move – pre or post Obamacare). When comparing, keep in mind, the ACA offers subsidies for monthly premiums on the health care exchanges for households with income up to 400% of the US poverty line. And you can calculate your subsidy via calculators on your state’s exchange website or via this subsidy calculator.

Affordable Care Act Open Enrollment Deadlines

How can you Find Prices and Enroll in a Plan Through a Public Exchange?

Some states elected to run their own exchanges, in which case, you would need to run through a state exchange. Others deferred to the federal government, and you would enroll in a plan on healthcare.gov.

To find out if your state is running their own exchange or deferred the healthcare.gov site will guide you.

To find out pricing and enroll, there are 4 steps:

Set up an account here (if your state has deferred, they will have their own site to enroll on)

Fill out the online application

Compare plans and pricing

Enroll

You will need your SS#, income statements, and other basic personal information when enrolling.

Available Obamacare Plans

Whether state or federal exchange, you will have 4 (possibly 5) available options to choose from. They range from high monthly premium, lower out-of-pocket costs to lower monthly premium, higher out-of-pocket costs. The following aren’t guarantees, but guidance:

Platinum Plan: highest monthly premium, lowest out of pocket costs

Gold Plan: second highest monthly premium, second lowest out of pocket costs

Silver Plan: third highest monthly premium, third lowest out of pocket costs

Catastrophic Plan: firth highest monthly premium, fifth lowest out of pocket costs. This plan is only available to those under age 30 or those over 30 with low incomes who have received a hardship exemption from the fee.

In general, the healthier you are, typically, the less coverage you need. If you expect a lot of health care costs, the more coverage you need. Of course, you can’t predict everything, so there is a bit of a guessing game involved in choosing a plan.

That’s it, really. Obamacare at its simplest.

Obamacare Discussion:

Do you have employer-sponsored or government run insurance (Medicare, Medicaid)?

If you have a private plan or no insurance – have/will you be enrolling in a public exchange plan?

What early cost estimates have you seen on plans comparable to those offered privately?

2 Comments

Marcie

Great article GE. This is the most clear explanation of the new health care that I’ve read.

Our family has coverage purchased individually through “grandfathered” plans. The rates for the new Obamacare plans are pretty attractive especially when factoring in a subsidy. I’m going to review the new plans again, but we’ll probably stay with our current plans for now because we don’t qualify for a subsidy.

Make sure you compare apples to apples, when you can. I’ve been reading that the exchange plans are more generous in what is covered vs. private plans – but every plan will vary. Just make sure to do your homework.

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